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TinyEYE: Reconsidering Speech Therapy Practice Guidelines

The challenge of leadership is to be strong, but not rude; be kind, but not weak; be bold, but not bully; be thoughtful, but not lazy; be humble, but not timid; be proud, but not arrogant; have humor, but without folly. -Jim Rohn
During one of my presentations at the ASHA convention, I told the audience that it was time for me to be bold. It is clear that many regions are discussing the creation or adaptation of guidelines surrounding telepractice. When considering changes, I invite you to study if the guidelines serve to prevent or provide services. Now in my fourth year of improving access to speech and language services via telepractice, I would like to give some examples of how rules in various regions have unintentionally served to prevent services. While reviewing the examples and suggestions, keep in mind that telepractice is a medium through which a service reaches a need. Often that need is found in communities that are suffering in some way because: the location is remote or rural and does not have a Speech-Language Pathologist; the Speech-Language Pathologist has such a large workload that there is not enough help to go around; or the in-house SLP is temporarily away and there is no one in the region who can continue the care. Bottom line – when a region goes without a SLP for even one to two years, a generation of children miss that critical care. Telepractice gives SLPs a way to reach those children…if the rules let them.

Example One:

Preventing services: “Primary treatment via telepractice must be avoided.”
Providing services: “Primary treatment must be considered and offered as a service delivery option when same-location services are not available or sustainable.”

Rationale: Students should have the option to meet face-to-face via telepractice to receive individual training from a Speech-Language Pathologist. Telepractice is a tool that capable SLPs use to meet with students who would otherwise have little or no support. It helps SLPs provide effective services. SLPs employ best judgement when selecting students for the direct therapy option via telepractice, just as they do for same location visits. When best practice prevails, withholding direct treatment is not in the best interest of a student. If primary treatment must be avoided via telepractice, that tells me that all treatment must be avoided. If there were a SLP in the school who could easily provide regular, effective direct therapy; then telepractice probably would not be considered. Again – telepractice has been considered because the student needs a solution. Do we prevent or provide that solution?Example Two:

Preventing services: “Primary assessment via telepractice must be avoided.”
Providing services: “Primary assessment via telepractice may be considered as a means to initiate services when a same-location assessment is not attainable at the time of the need.”

Rationale: Geographically, if a child lives in a location where therapy is not available, most often the assessments are also not available. Best case scenario, the service may be available ‘next year’ due to waiting lists or the service is available if the family drives or flies to a location and pays privately for services. Bottom line – withholding an assessment prevents the follow up support. In my experiences, I have flown to communities to administer assessments. In many cases, I found myself thinking that I could have saved the flight money and came to the same conclusions using my on-line platform. I believe that SLPs should be empowered to make assessment decisions for telepractice just as they do for same location assessments. It starts by learning what the school needs in order to get the children the services (i.e. Standardized scores, consultation, therapy programs based on age-appropriate norms…). SLPs are excellent investigators and are trained to develop conclusions and support plans when given key information.

Example Three:

Preventing services: “The Speech-Language Pathologist must visit the student in the same location every fourth visit, when telepractice is integrated into the service delivery model.”
Providing services: “The Speech-Language Pathologist must monitor the student’s performance and outcomes while engaged in therapy via telepractice to ensure the program provides optimal results.”

Rationale: Through telepractice, SLPs provide services to students who live in different regions and even to our children who live oversees. If the SLP were mandated to do a same-location visit every ‘fourth’ visit, services would often stop. This is a sustainable recommendation for SLPs who integrate telepractice into their jobs to improve productivity and direct services in their own community; however, it only serves to prevent services for children who do not have same-location access to SLPs.Example Four:

Providing services: I am proud of the region that considers telepractice to be an ethical means to provide direct supervision of speech-language pathologist assistants.

Rationale: Considering the capable hands and trained minds of communication disorder assistants (CDAs) and Speech-Language Pathologist Assistants (SLPAs), many communities employ assistants to ensure all students receive regular therapy services. This happens when SLPs are not available to provide the intensity of service that is warranted for every child. The service must be provided under the supervision of the SLP. Well – if there is no SLP in the region, the therapy programs may not run. Even if there is a SLP working within the region, often driving around to schools to supervise does not serve to relieve his or her workload. The solution is supervising via telepractice. Today’s telepractice offers real-time and video options for supervising same-location and on-line therapy programs. SLPs can connect with SLPAs regardless of location to ensure the students are receiving service excellence and to support the assistants.Going from Good to Great

In closing, I am inspired by a legendary hockey player name Wayne Gretzky a.k.a. “The Great One”. When asked about moving from good to great, he shared, “I skate to where the puck is going to be, not to where it has been.” When considering the future or Speech-Language Pathology, maximizing our available pool of elite SLPs, and our collective power to grow an enriched generation of children, let’s look forward to where our technology is bringing us – it is bringing us to the need. Are you for preventing or providing that solution?